World Development Report 1984

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family planning and maternal and child health duras, and 62 percent in Nepal live more than an services and are under the general guidance of the hour away from the source of supply. These barri- Division of Family Welfare within the central Min- ers-lack of information and distance-are particuistry of Health and Family Welfare. Indonesia pro- larly high in sub-Saharan Africa: more than half vides family planning as part of maternal and child the eligible women in Senegal and Sudan are health services within the health system, but also unaware of modern contraceptive methods, and in uses single-purpose fieldworkers responsible to most African countries contraceptives are available the BKKBN. The Chinese program relies on joint only in urban areas. personnel in the health system but has a separate To reach the rural areas, family planning propolicymaking body for family planning and overall grams have placed special emphasis on extending population policy. No matter how service delivery the work of health centers into communities and is organized, all programs need some health households through the use of fieldworkers and backup. other outreach staff. Access has also been in- Other significant factors in the success of pro- creased in many countries by encouraging the prigrams are the degree of political commitment and vate sector to provide family planning services. the overall administrative capacity of government to coordinate the deployment, training, supervi- EXTENDING PUBLIC SERVICES THROUGH "OUTsion, and availability of staff. These influence the REACH." Until a decade ago almost all public family effectiveness of three program strategies for planning programs provided services from cenexpanding contraceptive use: increasing access to ters-usually clinics-and relied heavily on mediservices, improving service quality, and ensuring cal staff. Because health services were not well social acceptability. established in rural areas and medical staff were scarce, access to family planning as well as to med- Increasing access ical care was limited. Today many large family planning programs Perhaps the greatest achievement of family plan- have succeeded in using their health centers as a ning programs in the past decade has been to springboard for taking services and supplies into make information and services more accessible to the villages. those who need them. In twenty-three of twenty- * Paramedical workers have been trained to nine developing countries in which surveys have provide many methods formerly provided only by taken place, more than 80 percent of married physicians. In Thailand, for example, auxiliary women are aware of at least one effective method midwives insert lUDs and administer injectable of contraception. In urban areas of almost all of contraceptives. Elsewhere nonmedical workers thirty-six countries examined by the <strong>World</strong> Fertility distribute the pill; they receive careful training on Survey (WFS), family planning methods are avail- screening for contraindications, proper use, how able within an hour's travel from home. In Costa to deal with side effects, and referral procedures. Rica and Thailand most people in rural areas are * Staff based in clinics have been supplemented also less than an hour away from services. Further- with fieldworkers who provide a link between more, most public programs provide services free the clinic and the community (see Box 7.5). of charge or at heavily subsidized rates. Fieldworkers periodically visit homes and outlying But there are still many countries and areas in communities to refer clients to service outlets; to which information and travel costs are major distribute nonclinical methods such as the pill, obstacles to satisfying the unmet need of clients. condom, and spermicidal foam; and to reassure According to household surveys in Guatemala and users. In some cases fieldworkers also supervise Piaui State, Brazil, 15 percent of married women of local volunteers. childbearing age said that they would like to use 0 Official outlets have been increased by orgacontraceptives but did not know where to get nizing local supply depots for nonclinical meththem. In Nepal half of married women do not ods. Such local outlets in Mexico and Indonesia know of a method of contraception; about 15 per- assist the work of field staff and reduce costs to cent know of a method but not of an outlet. In clients. Honduras about a quarter of women are unaware The advantages of outreach are considerable: of either method or outlet. Of those women in fieldworkers take less time and money to train rural areas who know where to obtain contracep- than do medical professionals; health staff can tives, 32 percent in Colombia, 42 percent in Hon- spend more time on health care than they other- 140
Box 7.5 Family planning fieidworkers C'itrr-- a,dI I ee,ni-- u ;ir. T Id- id.-rl,,cr; health cirrirmzittcs ti, pr,-~idJr pill; ca-n- z,Tnial, %tiunri-er -mnciudinA ;atistied ha-3. h t, , ki- T. . : %_. ; ; In , t Ja)n-~ arnd rhcr ba; h.-aitP ¾ ' Ie - i-nt'~ 1:arb-r. andti t,ahers-t,i)nixirm narri,.n ii anl plann.Trnl, pr--cr3mni- -lac~ i \iIner are -tler -a ha O.upl.- about a-. ilablE serict" reach r- nfl r th icTr elan-n I .. - t -I it-It. t paid .-ri-r, aiiid -- I.: F-3itaii rh.rn Th.i ad-. nta,-c c:i itamil . plann-tnns -'tian-iid -- ~ :-- cn- aLntractpir' Co.-igtr e pr.. ,i f-:n-:~ has nc:-'ura:e hr.-atit ding~ and c:hiidspa ra.:~pi i. u-:- I-..t br inging 'el '-3 r h,djl- 2's p,-reent c,-mnpar-d i.iith rare ing diisrithu nltiiilinical .-ncth,.d, andi J dric,ri.. r-. h,-r,ri.,ari,- F - in - 1'percent In lth rest ot thte c-untr. ret-jr c:I...-ta r. ramil. -ilittI cente-r, ic,r dirt..r, ni t-urittir- rllu, tr.tre~ a di'. er'. Full-tnme Faid iamil, plan. ,- he r ni, rt-i.d ThE olunt-aer, art * hpprliTLh t-hi tra-rine Ju ad r n"-tic -ld1.rr - ua mid.t irained and upc~r'.-d tC. n-n male aind - . iji *i tie I lii.- race 1 -rk-:r- * ir F.rnid planning ~.: r ice- at- ~~and nr-t ,r ~ub- ni, r- de,-aru a, ,gned iu h,aith it, -m v.%hich the, -p['td at onr lrmale -i srkcr at The lanmik center -.altar.. ,.,I -b rtdj hi mialt and in rle d muiLJtipu.r 1,-a-i tlir,n *iaa-, ach mnnrth niak'rir * Plhi-Ii'p'?. lit-_ut 3 iii .u -tr-a.ah p.>c Femak . ni-i-i, ni~~~rI~er. r'~ .i ide in-rm, . sir. arind orzanc_in,z g~-'ap mee -. r,r n: ie -e. 2h1legiN iau. pr..- an-i p ~pr-i d 1,amil -ia ic ri-c._ p-l.inn.r.g, fl. rN' fluiherfai- iIi in.-rIt'. drii .:gh. c.ui- fh1K alir.ribur,. cundint-~ eind p11'~ and ret.: r pe imp.hiov-.c t.-i.a ull-iimt vzi-.rnnienl £a~ ac- IC-rk-r rec,ruit, train, Ir bthi , -n.lc.ni - ,r.ij dIv. :r b-.bi.- fi i,- ILr riand ;t,.rd.Iz: an-n cli,nt~ T- i. d, 'ig - nd-~ur-r r-. i., aklut ,'.ertr Ci -mmur'ith IT.,rr, rit has r,-..r. tI-, -ai ri.n,-dr- .r: i-. planiii., .'-raz. cilK .liit---h- r-i. itrati t-. li- triOur ,IT it ,c-i ml -.-. 'r,ra-epi,~t. I..- Li.pra.'i.:ied-.rir -*.11i mat- cOupir- suppla .'nim aid pill, In inial',-kr-i rIir- 3tiirain-,d iT., i nl.ni "-rouc-.ae atii-n utErrci u,,.r' and moake~ retenral, rc. en - :dii-,n -i,ii-Ntetranir n and - IMht Lli- r.ai in rural area,-I ionen p.. r ,rnm- n-i health ,lni. I'ME ;i (iih 1,J ,-.i,.h aic.pt-:.r nir-i.t. be rmi, - a 'I-2III ct0F-i- than in, ure.cne ptr Linttier - aln.iz:ii hre~-j.)urler: oii d..i. r t1hin ihIr,-. n)i.;t, tial,,- irk- r -iii -..uple'i b-au.- t gl-ate,r dis- the natic-n r h,lgbe.t pe The lunar, ti. trnniair.. -. , n o.r.-nm-roai ta3r..,., in. tnt .1 oI3 'thr .iair'r h preigran I- un-:triain. -ant -nhUt ,i- .1- pr.. ii.. tanila plaiio I T-. n, ut-aipi-rm pr-.. -,cau.- -a,t-:rnAl lundin: I' Ill t,minate I nri. n di,n. i,,rtinat.in and disiribiate .ioi- H r..tf' h-nr tII- ire t rptcr,i ~ i-I.- ,,dvt-nt urr-,,ch -,-r i,thr.ugl-, irtnr % ni.n a.4-n, I, ti.ur dii. TI-, ere - in iu, 5 rz .,rd 1-cil g.i.--tnmc-tir 1.--,.f.nAit: I,. ii a,--r ii ct hra%-.. ni-it ,.t tih, i.. :.,rit 1 Flipulatii.n .-Ii5iiii i 3- Ilii in t,ri:t i-i Hv-aith and.J i-, liar'. tri3, I h,eld.- CItktc ,ar i. as arapidl a rn h,I I - and tr IbalI ar Ea a tI -i,- u kh in"ITIprkirp-l.: Iwiid-.I,tl,,:t - lit. c -nleer -. ..pecred Iri,.- nan - iri I t Indi JIa tI I I....lat h cira,t,. mai,nl ..-r- t,if-mil pI-nnIng Tih., a TbaItt.'i L n t II r:,-n,il.. ti-, Tha. nI, .. t 1',-en ac-,r-. ii lo-cal . -lr.,--..ho- rcri.- 'n-,all na,ii,.-nal pr-otani ha' It-_ r. dmi: ba-ed 6 i111. ii.. a.. i n the I l,,rd .- I Ia. -aard inc-:ni- e pa-. n-tnt- I i --. a -.cutt u -mulipurp.,-t n ila t3iulth -A unha.lt ri-.r tI- jt. ..-ut -n; lan-ai 1 , planning tnIttit.t- rut',a pr- -iran- tread Ii i-.a-l i- 'r-in nearla halt di th,. rati,-n . Ii. ld,-rI-i't T.. ri :-ONit elgiht, cou n, ' rann tradittnil-rinImi.v r'L lg.~i.I ,en rraii-JI I-.. prit tdc r-',- Th-,- i,ld. rIi' I-,at-. n- riticil. arni It-ithc I-cA uriiutc.rtTi-I prc-i itk antil planning tr-ilirmati,.n arid jalt --IInhJIr. -Y..hoi -rau-ie - r.-:ruit ni.i ni,--woi atin and -uppbe- i -hag:tot ,atre I--, re..uppl. p-ill and -~-iii Fl" --- i. Pr d : iYb, niana~-r,,i lml i_rarran Pti mai anrd ti-, N,Jmri-n I 5'. ient- tltr a nt-i,L],: 5t';.lit-Ctii._ ll. - liii I--ri-i.-. lacaih .lini. ri ' an.1 prt- ii-T,. tr-nt tI trlu'ttgrai-dl Fani ' e-.-ri.n iii: Tht IJ hid, tpat:ir-4 arni 1 -40lot-r.' Ii.ilrur. illap- and a:-i'- .--- p ij sen.ic-. rhr--rig -urJ.a- Fanail l'Ia'rnin, iuCl.1prsaa ~~t II -itra- ,~ 1~flt r- -uppl. irt,r--ir-r under III,.- Nirnitta ol H.aith rr.--, d,-i Itriarici.. ii-'1-r.iiril-h.-i pr-.liid-d1 * P,4 ireu ln l'$is the -timn ni,n-, ..I thb..~r si-'cta a'd ha-j ab,ut 3iuii ttlI n - paid iiliir-.,In r-,roni r.tv toaiiiid it, pr-niarm ii- nr.lUdr -, tuil-tinme sizer.ip- -utIva, , h .. .--r - i-il.-it- I~..t hi-. pro4rtiti. rib.- ih, --ihv r r,m .i iiel.li:..kti-,t-,ard ... lmnifnufldt --I .rŽ- ,h. 7upp, ~-ral -nmtr:c..ptii es t i. land. t~~~~~~~~~~~~~~~~rite,-r..I- ir : atler .i ;i,- n ..as b.-a-l d rnaal ilUit-tht-.ughi r-..gular It- 'r - a N I., Th,- pri- wi,t,, ru.n Ch-p-tn tr-l-r~, -ti p.ttd1 Iiti. i-,rI-t-r' %F hiL it. A~ r, Pt,I-tt i-il train 3rt.)ilttt ;i'.' ii.d -. ler .. 1 -t -_-,1,Jn h~ 1l-t.-al pr. -irani 1i;-' --all retturi-d n'.I,- arid wise would; and community-based fieldworkers to maintain the quality of services. They should are often most aware of local needs. But the exten- concentrate on a few main tasks; additional ressive use of fieldworkers requires regular, support- ponsibilities must be introduced only gradually. ive supervision. They must be trained well at the Fieldworkers also require a good medical backup outset andi must receive periodic refresher courses and referral system so that any side effects that 141
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Public Disclosure Authorized Public
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Oxford University Press NEW YORK OX
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labor markets. And they have a vest
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8 The policy agenda 155 Population
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Boxes 1.1 The arithmetic of populat
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Glossary Demographic terms informat
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I I
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countries regain their momentum of
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4 Box 1.1 The arithmetic of populat
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example. Between 1955 and 1980 inco
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ment-all the more so if human skill
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etween 1 and 2 percent-moderate com
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FIGURE 2.1 directions-with a lag in
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14 Distribution of product among se
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TABLE 2.2 Rates of growth in the re
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export restraints and orderly marke
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Box 2.2 Comparisons between the 193
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TABLE 2.6 indebtedness is denominat
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TABLE 2.7 Change in export prices a
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Burundi, Guinea, Mali, Malawi, and
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TABLE 2.9 Exports from developing c
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of rapid and painful adjustment for
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In many countries internal adjustme
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3 Prospects for sustained growth Wi
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TABLE 3.2 Growth of GDP per capita,
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TABLE 3.4 Current account balance a
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over time. The main focus of indust
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TABLE 3.6 Growth of trade in develo
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Box 3.3 Delinking from the world ec
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nal surplus. The resulting rise in
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Because the public sector in low-in
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developing-country creditworthiness
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themselves and, by caring for young
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fertility in a changing world is a
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nize contraceptive services. As wil
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Economic transformation: Europe, Ja
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scious control of family size, prob
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Box 4.3 The European fertility tran
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FIGURE 4.2 Birth and death rates an
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Box 4.4 Alternative measures of fer
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largest city in 1950, will not even
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FIGURE 4.4 Fertility in relation to
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government goal is a nationwide rat
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North America's population in 2000
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IBox 4.6 Three views of population
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TABLE 4.6 Population size and densi
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Box 5.1 Consequences of population
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implied by a simple division of tot
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and on farms. But the evidence on e
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get in GDP. Alternatively, all or p
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youths, who are presumably able to
Page 104 and 105: saving because they come from the c
Page 106 and 107: acre increased from 15.4 million to
Page 108 and 109: food they need. Although the amount
Page 110 and 111: is so scarce, they can do so only o
Page 112 and 113: from rural to urban areas mainly re
Page 114 and 115: other developing countries suggests
Page 116 and 117: emigration by providing information
Page 118 and 119: Box 5.7 Coping with rapid fertility
Page 120 and 121: 6 Slowing population growth Experie
Page 122 and 123: feTtility; nor is it easy to judge
Page 124 and 125: the education of mothers increases
Page 126 and 127: etter education and health services
Page 128 and 129: TABLE 6.1 Total fertility rates and
Page 130 and 131: effectiveness of existing laws, ins
Page 132 and 133: in the 1950s and 1960s, fertility w
Page 134 and 135: FIGURE 6.6 Fertility dedine within
Page 136 and 137: Box 6.3 Mleasuring the value of chi
Page 138 and 139: few births; to encourage spacing, T
Page 140 and 141: Box 6.4 A deferred incentive scheme
Page 142 and 143: Box"7.1 Family planning for health
Page 144 and 145: FIGURE 71 88 in Romania (1979). Res
Page 146 and 147: 132 Box 7.2 Birth planning technolo
Page 148 and 149: TABLE 7.2 Percentage of married wom
Page 150 and 151: TABLE 7.3 Discontinuation of contra
Page 152 and 153: may be delaying a first pregnancy,
Page 156 and 157: clients may develop can be promptly
Page 158 and 159: Box 7.6 The impact of service quali
Page 160 and 161: medical examination was not always
Page 162 and 163: measuring social acceptability, or
Page 164 and 165: Box 7.7 Military versus social expe
Page 166 and 167: costs per user. Public cost per use
Page 168 and 169: sanguine, however, as soon as one t
Page 170 and 171: TABLE 8.1 Population policy indicat
Page 172 and 173: Box 8.2 China's census: counting a
Page 174 and 175: FAMILY PLANNING. In many countries-
Page 176 and 177: improving the availability of famil
Page 178 and 179: Box 8.4 Africa: how much land, how
Page 180 and 181: Box 8.5 Infertility: a challenge to
Page 182 and 183: FIGURE 8.2 upper Egypt want no more
Page 184 and 185: growth. Fertility has declined in t
Page 186 and 187: Box 8.7 Changing policies and attit
Page 188 and 189: FIGURE 8.6 childbearing age have un
Page 190 and 191: able several types of condoms, pill
Page 192 and 193: housing schemes to parents with onl
Page 194 and 195: and training, data collection and a
Page 196 and 197: 9 Ten years of experience Much that
Page 198 and 199: ecause few effective methods are of
Page 200 and 201: Population data supplement The six
Page 202 and 203: Table 4. Factors influencing fertil
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190 Births and total fertility =Ice
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Table 1. Population projections Rat
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Table 2. Population composition Low
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Table 3. Contraceptive use and unme
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Table 5. Status of women Number enr
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Table 6. Family planning policy _ _
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Bibliographical note This Report ha
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Background papers Note: Source refe
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-1984. "The Malthusian Case: Preind
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I I
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Table 10. Structure of merchandise
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Key In each table, economies are li
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same order is used in all tables. T
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Population I~~~~ - * S: ~ -- ' X -
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Table 1. Basic indicators GNP per c
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Table 2. Growthi of production Aver
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Table 3. Structure of production GD
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Table 4. Growth of consumption-and
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Tadble 5. Structure of demand Distr
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Table 6. Agriculture and food Value
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Table 7. Industr Distribution of ma
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Table 8. Commercial energy Energy c
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Table 9. Growthi of merchandise tra
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Table 12. Origin and destination of
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Table 13. Origin and destination of
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Table 14. Balance of payments and r
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Table 15. Flow of public and public
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Table 16. External public debt and
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Table 17. Terms of public borrowing
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Table 18. Official development assi
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Table 19. Population growth and pro
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Table 20. Demographic and fertility
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Table 21. Labor force Percentage of
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Table 22. Urbanization Urban popula
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Table 23. Indicators related to lif
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Table 24. Health-related indicators
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Table 25. Education Number Number e
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Table 26. Central goverrnment expen
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Table 27. Central government curren
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Table 28. In-come distribution Perc
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Technical notes This edition of the
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difficulties in assigning subsisten
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series in national currencies are a
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Public loans are external obligatio
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estimates, the total fertility rate
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expenditure and current revenue sho
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Bibliography of data sources Nation
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World Development Report 1984

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